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Synchronous ipsilateral cavernous malformations of the trochlear nerve.
Christopher S Graffeo1, William R Copeland1, Perkins Mukunyadzi2
1Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States.
Summary
This case report details the first instance of two simultaneous trochlear cavernous malformations (CM). Surgical resection was successful, highlighting CM as rare but significant neurological mass lesions.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Malformations
Background:
- Cranial nerve cavernous malformations (CM) are rare congenital vascular anomalies.
- Only 44 cases of cranial nerve CM have been previously reported.
- This study presents the fifth case of trochlear nerve CM and the first report of two simultaneous CM on the same nerve.
Observation:
- A 57-year-old man presented with diplopia and complete left trochlear nerve paralysis.
- MRI revealed a 1cm enhancing lesion in the left ambient cistern.
- Intraoperative discovery of a second, discrete CM on the trochlear nerve.
Findings:
- Complete surgical resection of both trochlear nerve CM en bloc with negative margins.
- Pathologic analysis confirmed both lesions as CM of the trochlear nerve.
- Patient recovered with persistent trochlear paralysis; follow-up MRI showed no residual or recurrent disease.
Implications:
- Cranial nerve CM are rare but can cause significant neuropathies.
- Differential diagnosis should include schwannoma and hemangioblastoma.
- Surgical resection is recommended for symptomatic patients, potentially with nerve repair.
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